A 23-year-old male visits his GP complaining of natal cleft pain, along with purulent and bloody discharge from the area. He also has a fever. This is not the first time he has experienced these symptoms, as he has had similar episodes over the past three years. Typically, the symptoms resolve on their own, but return after a period of being asymptomatic. However, he underwent incision and drainage for his condition six months ago, and the symptoms have returned once again. What is the most effective treatment option for this individual?
MSFinals-6440
A 67-year-old man with a past medical history of dyspepsia presents with a gastric MALT lymphoma confirmed on biopsy. What treatment options are available?
MSFinals-6404
A 65-year-old man with benign prostatic hyperplasia complains of lower abdominal pain and difficulty urinating. Upon catheter insertion, over 2L of clear urine is drained, providing immediate pain relief. Three hours later, the patient reports pale pink urine color but is otherwise feeling well with stable vital signs. What is the best course of action for management?
MSFinals-6405
A 25-year-old woman is brought to the hospital by air ambulance due to dyspnoea and severe chest pain after being thrown from a horse and trampled during an event.
Upon examination, there is a decrease in breath sounds on the left side of the chest with hyper-resonant percussion, and the apex beat is shifted to the right. Additionally, the patient’s right arm appears to have a closed humeral fracture.
Considering the examination results, which medication should be used with caution?
MSFinals-6406
A 72-year-old male who is 84kg is on the general surgical ward following an open right hemicolectomy with primary anastomosis and a covering loop ileostomy two days ago. The operation went well, but he has been struggling with pain and nausea postoperatively, and as a result has been unable to tolerate oral intake. He has been given 1 litre of Hartmann’s solution and 2 litres of 5% dextrose solution maintenance fluid per day, as well as regular morphine IV and ondansetron IV twice daily. He also takes regular furosemide for blood pressure.
The nurse has called you to review him as he has become confused this morning, and his blood pressure has fallen.
On examination, he appears well, although confused, with an abbreviated mental test (AMT) score of 7/10. His surgical site is healing well, although he complains of some tenderness on palpation, and bowel sounds are absent. His stoma bag has a small amount of bilious content. Fluid balance is neutral, and mucous membranes are moist. Examination is otherwise normal.
Observations are below:
BP 104/74 mmHg HR 93/min RR 14/min O2 Sats 99% Temperature 37.4ºC
His blood results from this morning are below:
Hb 140 g/L Male: (135-180) Female: (115 – 160) Platelets 269 * 109/L (150 – 400) WBC 9.7 * 109/L (4.0 – 11.0) Na+ 123 mmol/L (135 – 145) K+ 5.2 mmol/L (3.5 – 5.0) Bicarbonate 25 mmol/L (22 – 29) Urea 8.7 mmol/L (2.0 – 7.0) Creatinine 101 µmol/L (55 – 120) CRP 3.2 mg/L <5
What is the most likely cause of this patient’s confusion?
MSFinals-6407
A 32-year-old construction worker presents with intense pain in his right flank. He has no significant medical history. After administering appropriate pain management, he reports that he has never encountered this issue before. He often works outside without access to water and has recently started bodybuilding, resulting in an increase in protein consumption. A scan is scheduled to confirm the diagnosis.
What would be the likely diagnosis?
MSFinals-6408
A 50-year-old woman presents to the surgical assessment unit with worsening upper right abdominal pain after dining out with friends. She reports experiencing this pain for the past few months, but it has never been this severe. The pain tends to worsen after dinner, especially with fast food, and occasionally radiates to her right shoulder. Upon examination, you note an increase in body weight. Her abdomen is soft and non-tender, and bowel sounds are present. She is currently not running a fever. What is the definitive treatment for this condition?
MSFinals-6409
Ms. Johnson, a 48-year-old woman, arrives at the emergency department complaining of acute epigastric abdominal pain, nausea, and vomiting that started 24 hours ago. She reports that the pain worsens after eating and lying down, but improves when she leans forward. Although she has experienced colicky upper abdominal pain in the past, she claims that this has never happened before. Upon observation, she appears to be sweating profusely and has a large body habitus. Mild scleral icterus is also noted during examination. While waiting for the results of routine bloods and a serum amylase, what would be the immediate next investigation you would want to perform for this patient?
MSFinals-6420
A 65-year-old woman with a T4N0M0 primary triple-negative breast carcinoma is attending a pre-operative breast oncology clinic. The oncologist recommends neo-adjuvant chemotherapy (NACT) as a beneficial course of treatment. What should the patient be informed of when considering whether to undergo NACT?
MSFinals-6421
A 67-year-old man undergoes a subtotal colectomy and suffers iatrogenic injury to both ureters. He experiences renal failure and his serum potassium level is elevated at 6.9 mmol/L. An ECG is conducted, what is the probable result?